Provider Demographics
NPI:1700892429
Name:TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:RENDER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-349-4314
Mailing Address - Street 1:675 COX HOLLOW RD
Mailing Address - Street 2:TRAIL OF THE CUMBERLANDS ANESTHESIA ASSOCIATES
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3150
Mailing Address - Country:US
Mailing Address - Phone:423-349-4319
Mailing Address - Fax:423-349-0799
Practice Address - Street 1:1850 OLD KNOXVILLE HWY
Practice Address - Street 2:CLAIBORNE COUNTY HOSPITAL
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879
Practice Address - Country:US
Practice Address - Phone:423-626-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3629220Medicaid
TN3629220Medicaid